Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | JUST-GRADUATED | MA |
NPI | 1013680420 |
---|---|
Provider Name | Chloe Wagen |
First Address | Boston, MA 02134-1461 |
Second Address | Boston, MA 02115-2833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2021 |
Last Update Date | 30/07/2021 |